Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee; University of Tennessee Health Sciences Center, Memphis, Tennessee; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
Pediatr Blood Cancer. 2014 Oct;61(10):1811-5. doi: 10.1002/pbc.25101. Epub 2014 Jun 12.
Long-term central venous catheters (CVCs) are essential to modern pediatric oncology practice, but central line-related bloodstream infection (CRBSI) is a frequent and important complication. CVC salvage is often attempted but treatment failure is common due to persistent infection, delayed catheter removal, or subsequent relapse of infection, which can be associated with significant morbidity and cost. Adjunctive antibiotic lock therapy (ALT) has been proposed to reduce the risk of treatment failure, but insufficient data are available to confirm efficacy of this intervention.
We undertook a retrospective matched cohort study of ALT use for treatment of CRBSI in pediatric hematology/oncology patients at St. Jude Children's Research Hospital between 2006 and 2012.
Thirty-eight eligible episodes of CRBSI treated with adjunctive ALT were identified and compared to 73 episodes treated with standard therapy (ST) alone, matched by catheter-type and organism. Overall, treatment failure was similar between ALT and ST groups (50.0 vs. 38.4%; P = 0.24), but the timing was different; in the ALT cohort, immediate CVC removal was less common (0.0 vs. 12.3%; P = 0.03) but delayed removal (4-13 days) and relapse of infection was more common (50.0 vs. 24.7%; P = 0.01).
This retrospective study was unable to identify any benefit of adjunctive ALT in pediatric oncology patients with CRBSI. The available evidence does not support routine ALT use, and well-conducted prospective studies are needed.
长期中心静脉导管（CVC）是现代儿科肿瘤学实践的重要手段，但中心静脉相关血流感染（CRBSI）是一种常见且重要的并发症。通常会尝试进行 CVC 修复，但由于持续感染、导管延迟拔除或随后感染复发，治疗失败很常见，这可能会导致严重的发病率和成本增加。辅助抗生素锁治疗（ALT）已被提议用于降低治疗失败的风险，但目前的数据不足以证实该干预措施的疗效。
我们对 2006 年至 2012 年期间圣裘德儿童研究医院儿科血液科/肿瘤科患者因 CRBSI 接受辅助 ALT 治疗的病例进行了回顾性匹配队列研究。
确定了 38 例符合条件的 ALT 治疗 CRBSI 病例，并与 73 例仅接受标准治疗（ST）的病例进行了匹配，按导管类型和病原体进行匹配。总体而言，ALT 和 ST 组的治疗失败率相似（50.0% vs. 38.4%；P=0.24），但时机不同；在 ALT 组中，立即拔除 CVC 的情况较少（0.0% vs. 12.3%；P=0.03），但延迟拔除（4-13 天）和感染复发的情况更为常见（50.0% vs. 24.7%；P=0.01）。
这项回顾性研究未能确定辅助 ALT 在儿科肿瘤学 CRBSI 患者中的任何益处。现有证据不支持常规使用 ALT，需要进行精心设计的前瞻性研究。
